[Question #5859] HIV 1 RNA, QL TMA accuracy

19 months ago
Hi Doctors, what is the accuracy of HIV 1 RNA, QL TMA test on the 21st day after the possible high exposure event. I had HIV 1 RNA test on 14th day and it was NOT DETECTED and a hiv 4th gen and RNA test on 21st day both were negative. I started having pain in my armpits and behind my ears could be lymh nodes on the 15th day and started getting anxious and worried. What are the accuracy of the above results. Should I do another test after 4 weeks? did you ever come across or see a 21st day RNA negative test turned out to be possitive.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Welcome to the forum. Thank you for your confidence in our services.

The RNA test detects 80-90% of HIV infections 14 days after acquiring the infection and nearly 100% (at least 95%, maybe 99%) at 21 days. The antigen-antibody test (AgAb, 4th generation, duo, combo) at 21 days detects around 90% of infections. The combination of all those test results is virtually 100% already. Another AgAb test at 4 weeks will make it definitely 100% conclusive.

No, I have never had a patient with negative RNA at 21 days who turned out to have caught HIV.

You have said nothing about the exposure you are concerned about. If you would like to provide that information, I might have additional reassuring advice. In the meantime, I hope this reply is helpful. Let me know if anything isn't clear.

HHH, MD
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19 months ago
Thank you Dr, it was helpful. I had a handjob at an asian massage parlor, sucked her nipples and touched her vagina with my fingers around 25 days ago. I though its a no risk event and forgot about it.
 I started having pain in my armpits and behind my ears after 12th day and felt little bubble like enlarged area inside skin and that made me anxious and scared. Is there a possibility of getting HIV without some kind of sexual intercourse and or directly injecting hiv blood into the body.
 I have been searching online and started worrying about things like what if she has cuts on her hands or i had on my penis or I had cuts on my figer touched are vagina or got breast milk into my mouth. Can I take one more 4th gen test after 4 days (29th days) and consider the 100% conclusive.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
You had a zero risk exposure, even if your partner had "cuts on her hands" or you had the same on your penis. "Pain in the armpits and beyind my ears" and your other sypmtoms do not even hint at HIV. You did not need aHIV testing.

But let's assume there was some extremely low risk for HIV, say 1 chance in 10 million. You now have had tests that are 99% reliable, i.e. 1% chance you have HIV despite the negative result. Mathematically, combined with a risk fo 1 in 10 million, the chance you have HIV in view of these test results is now 1 in a billion. On the other hand, if you live in the US, the National Safety Council calculates there is one chance in 1,756 you will die in the next 12 months of an accident (auto wreck, drowning, a fall, etc). In other words, the chance you have HIV is 57,000 times lower than the possibility of dying accidentally in the next year. 

So my advice is to stop worrying and stop testing. And don't forget your seatbelt!
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19 months ago
Thanks for the response Dr.  I had no risk, even if I had risk irrespective of exposure and scenarios my com insertion of RNA and 4th gen test is 100% conclusive on the 21st day(3 weeks).
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Yes, you correctly understand.

That completes the two follow-up comments and replies included with each quesiton and so concludes this thread. I hope the discussion met your expectations. Best wishes and stay safe.
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